Hundreds of doctors paid millions a year through Medicare

New federal data has revealed some Medicare doctors to be earning millions of dollars in a single year through the program, and healthcare advocates are hoping the new information can be used to help find and cut down on abuse in the future.

According to the Wall Street Journal, 344 physicians were paid
more than $3 million each in 2012. In total, the top one percent
of medical providers were found to receive about 14 percent of
the $77 billion Medicare paid out during that year.

In addition to detailing how much each doctor earned via
Medicare, the data – provided by the Centers for Medicare and
Medicaid Services – also reveals the types and number of
procedures that physicians ultimately billed the government
program for. While this information has always been available to
the CMS, healthcare watchers hope that with outside groups now
being able to view these billing practices, it will become easier
to highlight areas where unnecessary costs could be reduced or
where abuse may be prevalent.

"If you see that a doctor is doing a procedure hundreds or
thousands of times that should be done only on a small number of
patients, you wonder," Dr. John Santa of Consumer Reports
said to Reuters. "Are they committing fraud by billing for
something they're not actually doing, doing unnecessary
procedures because they're greedy, or do they practice someplace
where so many people need the procedure?"

The new data was released recently by the CMS despite objections
by the American Medical Association (AMA), which had successfully
blocked the agency from releasing information regarding physician
billings since 1979, claiming that doing so would violate the
privacy rights of doctors across the country. In 2013, however, a
district court judge ruled the data could be released as part of
a Freedom of Information Act request filed by Dow Jones, the
parent company of the Wall Street Journal.

The AMA told Reuters it "is concerned that (the government's)
broad approach to releasing physician payment data will mislead
the public into making inappropriate and potentially harmful
treatment decisions and will result in unwarranted bias against
physicians that can destroy careers."

As noted by the Journal, the CMS data is missing several key
specifics that would help place the numbers in context.
Specifically, the data does not reveal details of patients’
diagnoses or the dates on which procedures are performed,
information that would help determine whether or not a doctor is
carrying out an unnecessary service. Some doctors are also highly
specialized experts, which could explain why they bill Medicare
for so many expensive procedures.

Supporters claim that even if the data is not perfect, it will
help narrow focus onto areas worthy of further investigation.

"You'll be able to see back surgeons whose average bill is
$50,000 because they say almost all of the spinal fusions they do
are more complicated than the usual, and others whose average
bill is $5,000" because they do not claim such
complications, Santa told Reuters.

After the Department of Health and Human Services discovered that
303 physicians collected more than $3 million each in 2009,
“improper payment reviews” were initiated for 104 of them. The
investigation found that $34 million in overpayments had
occurred, leading to the suspension of three doctors’ medical
licenses and the indictment of two others.

Although doctors in the US are not required to accept Medicare
patients, the vast majority of them do. According to Reuters, 91
percent of doctors – not including pediatricians – continued to
accept new Medicare patients in 2013, and the program covers
about 50 million Americans.